Treatment outcomes of injured children at adult level 1 trauma centers: Are there benefits from added specialized care?

Background: Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ). Methods: The National Trauma Data Bank, version 7.1, was analyzed for patients aged \u3c18 years seen at level 1 trauma centers. Bivariate analysis compared patients by ATC versus ATC-AQ using demographic and injury characteristics. Multivariate analysis adjusting for injury and demographic factors was then performed. Results: A total sample of 53,702 children was analyzed, with an overall mortality of 3.9%. The adjusted odds of mortality was 20% lower for children seen at ATC-AQ (odds ratio, .80; 95% confidence interval, .68-.94). Children aged 3 to 12 years, those with injury severity scores \u3e 25, and those with Glasgow Coma Scale scores \u3c 8 all had significant reductions in the odds of death at ATC-AQ. Conclusions: Improved overall survival is associated with pediatric trauma patients treated at ATC-A

Epidemiologic trend in elderly domestic injury

Background: The elderly constitute about 12% of the American population, with a projected increase of up to 25% in 2050. Elderly domestic injuries have been recognized as a major cause of morbidity and mortality. The objective of this study is to determine the 4-y national trend in elderly domestic injury, and we hypothesize that the home remains a significant source of injury. Methods: Data on elderly patients ≥ 65 y was extracted from the National Trauma Data Bank\u27s National Sample Project (NSP). Elderly patients with home injuries were compared with non-home injuries. Subsets of hospitalized patients were analyzed for trends in injury site over a 4 y period. Multivariate analysis was performed to determine the predictors of hospitalization and in-hospital mortality. Results: A total of 98,288 patients, representing a weighed estimate of 472,456 elderly patients were analyzed. Forty-two percent of all injuries in the study population occurred at home, followed by motor vehicle crashes (MVC) at 25%. Home injuries as a proportion of annual injuries increased from 37% in 2003 to 40% in 2006. Majority (57%) were admitted to the floor and 14% to the intensive care unit (ICU). On multivariate analysis, African-Americans and Asians were less likely to be hospitalized (odds ratio (OR) 0.57 and 0.50, respectively, with females 47% less likely than males to die after hospitalization (P \u3c 0.001). Conclusions: Home injuries remain the most significant source of elderly hospitalizations after trauma. With a rapidly growing elderly population, there is a need to recognize this specific location of injury and create directed preventive measures to avert elderly domestic injurie

Racial, Ethnic, and Insurance Status Disparities in Use of Posthospitalization Care after Trauma

Abstract available at publisher's web site.http://dx.doi.org/10.1016/j.jamcollsurg.2011.08.01

Pedestrians struck by motor vehicles further worsen race- and insurance-based disparities in trauma outcomes: The case for inner-city pedestrian injury prevention programs

Background: Pedestrian trauma is the most lethal blunt trauma mechanism, and the rate of mortality in African Americans and Hispanics is twice that compared with whites. Whether insurance status and differential survival contribute to this disparity is unknown. Methods: This study is a review of vehicle-struck pedestrians in the National Trauma Data Bank, v7.0. Patients \u3c16 years and \u3e or =65 years, as well as patients with Injury Severity Score (ISS) \u3c9, were excluded. Patients were categorized as white, African American, or Hispanic, and as privately insured, government insured, or uninsured. With white and privately insured patients as reference, logistic regression was used to evaluate mortality by race and insurance status after adjusting for patient and injury characteristics. Results: In all, 26,404 patients met inclusion criteria. On logistic regression, African Americans had 22% greater odds of mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06-1.41) and Hispanics had 33% greater odds of mortality (OR, 1.33; 95% CI, 1.14-1.54) compared with whites. Uninsured patients had 77% greater odds of mortality (OR, 1.77; 95% CI, 1.52-2.06) compared with privately insured patients. Conclusion: African American and Hispanic race, as well as uninsured status, increase the risk of mortality after pedestrian crashes. Given the greater incidence of pedestrian crashes in minorities, this compounded burden of injury mandates pedestrian trauma prevention efforts in inner cities to decrease health disparitie

Motorcycle helmets associated with lower risk of cervical spine injury: Debunking the myth

Background: There has been a repeal of the universal helmet law in several states despite definitive evidence that helmets reduce mortality, traumatic brain injury, and hospital expenditures. Opponents of the universal helmet law have successfully claimed that helmets should not be required because of greater torque on the neck, which is thought to increase the likelihood of a cervical spine injury. There is currently insufficient evidence to counter claims that helmets do not increase the risk of cervical spine injury after a motorcycle collision. The objective of this study was to determine the impact of motorcycle helmets on the likelihood of developing a cervical spine injury after a motorcycle collision. Study design: We reviewed cases in the National Trauma Databank (NTDB) v7.0 involving motorcycle collisions. Multiple logistic regression was used to analyze the independent effect of helmets on cervical spine injury. Cases were adjusted for age, race, sex, insurance status, anatomic (Injury Severity Score) and physiologic injury severity (systolic blood pressure \u3c 90 mmHg), and head injury (Abbreviated Injury Score \u3e 3). Results: Between 2002 and 2006, 62,840 cases of motorcycle collision were entered into the NTDB; 40,588 had complete data and were included in the adjusted analysis. Helmeted riders had a lower adjusted odds (0.80 [CI 0.72 to 0.90]) and a lower proportion of cervical spine injury (3.5% vs 4.4%, p \u3c 0.05) compared with nonhelmeted riders. Conclusions: Helmeted motorcyclists are less likely to suffer a cervical spine injury after a motorcycle collision. This finding challenges a long-standing objection to mandatory helmet use that claims helmets are associated with cervical spine injury. Re-enactment of the universal helmet law should be considered in states where it has been repeale

Association between insurance status and hospital length of stay following trauma

Previous research has demonstrated that nonclinical factors are associated with differences in clinical care, with uninsured patients receiving decreased resource use. Studies on trauma populations have also shown unclear relationships between insurance status and hospital length of stay (LOS), a commonly used metric for evaluating quality of care. The objective of this study is to define the relationship between insurance status and LOS after trauma using the largest available national trauma dataset and controlling for significant confounders. Data from 2007 to 2010 National Trauma Data Bank were used to compare differences in LOS among three insurance groups: privately insured, publically insured, and uninsured trauma patients. Multivariable regression models adjusted for potential confounding due to baseline differences in injury severity and demographic and clinical factors. A total of 884,493 patients met the inclusion criteria. After adjusting for the influence of covariates, uninsured patients had significantly shorter hospital stays (0.3 days) relative to privately insured patients. Publicly insured patients had longer risk-adjusted LOS (0.9 days). Stratified differences in discharge disposition and injury severity significantly altered the relationship between insurance status and LOS. In conclusion, this study elucidates the association between insurance status and hospital LOS, demonstrating that a patient\u27s ability to pay could alter LOS in acute trauma patients. Additional research is needed to examine causes and outcomes from these differences to increase efficiency in the health care system, decrease costs, and shrink disparities in health outcomes